jcda
ca
ESSENTIAL DENTAL KNOWLEDGE
The following is a summary of an article recently published in the Clinical Dentistry
The Canadian Dental Association
section of the JCDA website. For the full version, see jcda.ca.
Published by
jadc
Clinical
Summaries
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
CLINICAL REPORTS
Publié par
l’Association dentaire canadienne
Lateral Window Sinus Elevation Technique: Managing Challenges
and Complications
Suzanne Caudry, PhD, DDS, MSc Perio; Michael Landzberg, DDS, MSc Perio, FRCD(C)
Abstract
Sinus floor elevation is commonly used in cases where alveolar bone resorption
has led to insufficient bone height for the placement of dental implants. Lateral
wall sinus elevation is carried out when the bone is severely deficient. Although
this procedure has a high rate of success, it may present surgical problems. A
description of the anatomy of the maxillary sinus and lateral wall augmentation
techniques leads to a discussion of the various challenges and complications that
may arise and their management.
I
n dentistry, the replacement of single teeth with implants is common in the appropriate patient population. Dental implants are very predictable and can often be
placed without the need for adjunctive surgical procedures. However, in a variety of
situations, bone is inadequate for implant placement. The posterior maxilla is frequently deficient in bone in the vertical dimension because of the close proximity of
the maxillary sinus to the roots of the premolar and molar teeth.
Preoperative periapical shows minimal
bone height at site 16 (top). Small
perforations of the Schneiderian
membrane can be repaired by placing
a resorbable collagen membrane over
the perforated area after it has been
elevated and before the addition of bone
graft (middle). Postoperative periapical
shows a round, contained shape of the
bone graft indicating that the repair was
successful (bottom).
More online
Complete case report and
additional photos at:
jcda.ca/article/d101
A technique for bone augmentation in this region by preparing a window in the lateral
wall of the sinus was first published in 1980.1 This approach provides access to the lateral sinus wall by raising a full-thickness mucoperiosteal flap from the alveolar crest
with vertical releasing incisions. High-speed surgical burs have traditionally been
used for preparation of a window in the lateral sinus wall to access the Schneiderian
membrane. Recently the use of piezoelectric units has been advocated as an alternative to reduce the risk of perforation of the membrane. Once access is achieved, the
membrane is carefully dissected from the surrounding bone in 3 dimensions using
curettes, and a bone graft is placed in the space that has been created. Implants are
placed either simultaneously or after the graft has healed. An alternative approach,
a transcrestal membrane elevation technique using osteotomes, was reported by
Summers, 2 and many variations on the transcrestal approach have been described.
Although a variety of techniques are available for augmenting the alveolar process
in this region, when bone deficiency is < 6 mm in height, the original augmentation
technique through a lateral window is highly recommended. 8 It is predictable for vertical growth of more than 4 mm of bone; however, it is surgically challenging and
presents various risks and complications. In this paper we discuss some of these and
suggest methods for their management. a
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